| NPI | 1497715593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 2623711204) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: UT 262371-1204) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: UT 262371-1204) | |
| 207Q00000X Family Medicine (Licence: UT 262371-1204) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2017-06-02 |